Lower extremity minor amputations: The roles of diabetes mellitus and timing of revascularization

Sheahan, Malachi; Hamdan, Allen D.; Veraldi, Jennifer; McArthur, Claudie; Skillman, John J.; Campbell, David R.; Scovell, Sherry D.; LoGerfo, Frank W.; Pomposelli, Frank B.

doi:10.1016/j.jvs.2005.05.003

Cited by 92 publications

(64 citation statements)

References 30 publications

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“…Campbell and colleagues 20 In-hospital or 30-day mortality figures after minor amputation are less readily available, but a rate of 0·7 per cent has been published 22 , comparable with the adjusted mortality rate for minor amputation of 3·6 per cent reported here. The significant variation in adjusted in-hospital mortality rate seen across SHAs for both major and minor amputations is likely to have a multifactorial basis.…”

Section: Discussionsupporting

confidence: 70%

Epidemiological study of lower limb amputation in England between 2003 and 2008

Moxey

Hofman

Hinchliffe

et al. 2010

British Journal of Surgery

164

138

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Section: Discussionsupporting

confidence: 70%

Epidemiological study of lower limb amputation in England between 2003 and 2008

Moxey

Hofman

Hinchliffe

et al. 2010

British Journal of Surgery

164

138

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“…14 End-stage renal disease is one of the recognized risk factors that worsen the prosthesis-wearing rate. 9,13 In this series, the renal function factor affected the preprosthetic training waiting time (P ϭ 0.001) and also influenced the daily prosthesis usage time (P ϭ 0.01). For patients with abnormal renal function (creatinine Ͼ1.4 mg/dl) that require amputation or revascularization surgery, surgeons should carefully explain the additional risks associated with abnormal renal function to the patient and families.…”

Section: Discussionmentioning

confidence: 77%

Influencing Factors of Outcome After Lower-Limb Amputation: A Five-Year Review in a Plastic Surgical Department

Chen¹,

Lee²,

Hsieh³

et al. 2008

Annals of Plastic Surgery

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The crude major lower limb amputation procedure rate is 8.8 per 100,000 of the population per year in Taiwan. From January 2002 to October 2006, patients that received major lower limb amputation in our department were enrolled in this study. Retrospective chart reviews concerning different factors that can affect the eventual postoperative functional status were investigated. Factors that affected the length of hospital stay included duration before amputation (P < 0.001) and renal function (P = 0.045). Phantom limb pain was affected by wound healing time (P = 0.006). Factors that affected the daily prosthesis usage time were initial infection status (P = 0.021), renal function (P = 0.01), patient educational level (P = 0.016), and pretraining waiting time (P = 0.003). The duration of prosthetic training was affected by patient educational level (P = 0.004) and marital status (P = 0.024). In addition, subjective satisfaction about the usage of prosthesis was affected by pretraining waiting time (P = 0.001) and daily prosthesis usage time (P < 0.001). The daily prosthesis usage time was closely related to life quality improvement (P < 0.001) and subjective satisfaction of prosthesis usage (P < 0.001). Despite reported unchangeable factors like age, end-stage renal disease, dementia, coronary artery disease, and level of amputation, preprosthesis training waiting time significantly affected the satisfaction and daily usage time of the prosthesis. Surgeons can make some contribution to accelerate amputation wound healing and stump maturation by choosing the correct operating procedure, delicately managing the soft tissue, and ascertaining proper wound care to improve the outcome.

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“…In patients with forefoot gangrene, attempts were made to optimize arterial perfusion to the affected extremity with revascularization, either open or endovascular, when possible. Sheahan et al 4 found that a revascularization procedure performed subsequent to partial foot amputation was a predictor of subsequent limb loss and advocated early revascularization to optimize amputation healing. In the current series, patients undergoing TMA following revascularization had healing rates no different from those of patients who underwent amputation without revascularization.…”

Section: Commentmentioning

confidence: 99%

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Landry

Silverman

Liem³

et al. 2011

Arch Surg

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Intervention: Transmetatarsal amputations performed in all patients.Main Outcome Measures: Transmetatarsal amputation healing, ambulation, living status, and survival. Demographic characteristics, preoperative vascular status, and perioperative variables were analyzed as predictor variables. Univariate and multivariate analyses were performed to determine predictors of healing and survival.Results: Sixty-two TMAs were performed in 57 patients. Healing occurred in 33 TMAs (53%), with 22 TMAs (35%) in patients who proceeded to below-knee amputation and 7 TMAs (11%) in patients who died without healing. No demographic or perioperative variables significantly predicted healing. Independent ambulation was achieved in 24 patients with healed TMAs (73%) but in only 4 patients with nonhealed TMAs (14%) (P Ͻ.001). Mean survival was 16.5 months (range, 0-94 months), with no difference between patients with healed and those with nonhealed TMA. Significant predictors of mortality were dialysis-dependent renal failure (odds ratio, 4.85; 95% confidence interval, 1.01-23.30) (P = .047), nonindependent living (17.80; 3.03-104.80) (P =.001), and need for preoperative revascularization (4.80; 1.24-18.50) (P =.02).Conclusions: Transmetatarsal amputations have low healing rates, and patient demographic characteristics and preoperative assessment do not help predict healing. Transmetatarsal amputation healing, however, significantly predicts subsequent ambulatory status and should be pursued in patients with good rehabilitation potential.

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Lower extremity minor amputations: The roles of diabetes mellitus and timing of revascularization

Cited by 92 publications

References 30 publications

Epidemiological study of lower limb amputation in England between 2003 and 2008

Epidemiological study of lower limb amputation in England between 2003 and 2008

Influencing Factors of Outcome After Lower-Limb Amputation: A Five-Year Review in a Plastic Surgical Department

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

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